Albertsons LLC
Organization Active NPI Community/Retail Pharmacy · Grants Pass, OR
NPI 1124473954 · NPPES record last updated Apr 3, 2020
Key facts
- NPI
- 1124473954
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- RP-0002020 (OR)
- Legal business name
- ALBERTSONS LLC
- Practice address
- 1690 SW Allen Creek Rd
Grants Pass, OR 97527-5559 - Phone
- (541) 471-7085
- Fax
- (541) 471-9047
- NPI assigned
- Apr 29, 2016
- Organization subpart
- No
Authorized official
- Name
- Kathy Giannakopoulos
- Title
- Enrollment Manager
- Phone
- (208) 395-3954
Corporate family (same tax ID) 12
Member of 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160816001509 | OR | DME Supplier - Pharmacy |
8729983515 | Practice locations: Grants Pass, OR |
National Provider Directory
- Tax ID family
- Albertsons 851
Locations
1690 SW Allen Creek Rd
Grants Pass, OR 97527
Phone (541) 471-7085
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | RP-0002020 | OR | Yes |
Addresses
Primary practice location
1690 SW Allen Creek Rd
Grants Pass, OR 97527-5559
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2159914 | Other | PK | |
| 1124473954 | Medicaid | OR |
Other names
- Sav-On Pharmacy #3541
Other providers in Grants Pass, OR
- Richard Aguilera
- Aaron Victor Aguirre
- Alvin H. L. Ahlstrom
- Crystal Ahlstrom
- Hala Mohamed Aly Ahmed
- David S Albrecht
- Susan Lara Albright
- Michelle Donna Alcala
- Selena Rose Alderson
- Rachel Alexanian
All providers in Grants Pass, OR · Community/Retail Pharmacy in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.